高渗氯化钠羟乙基淀粉注射液输注对急性颅内高压伴失血性休克犬脑组织病理学及氧自由基的影响

目的 观察高渗氯化钠羟乙基淀粉40注射液(HSH)在犬急性颅内高压伴失血性休克模型中恢复循环血容量、减轻脑组织水肿和降低脑组织氧自由基含量的作用.方法 健康杂种犬20只,采用硬膜外球囊注水和动脉放血的方法复制急性颅内高压伴失血性休克模型.动物随机分为羟乙基淀粉溶液组(HES组),乳酸盐林格液组(RL组),7.5%氯化钠溶液组(HS组)和高渗氯化钠羟乙基淀粉40注射液组(HSH组),在休克后1 h分别输入相应液体.监测平均动脉压(MAP)、中心静脉压(CVP)、心率(HR)、颅内压(ICP),检测脑组织丙二醛(MDA)含量、超氧化物歧化酶(SOD)活力,脑组织标本行病理学检查.结果 复苏后4组液体均能有效地升高MAP(P<0.05),但HES组和RL组的ICP上升明显(P<0.05),复苏后2 h,HS组的MAP开始下降(P<0.05).至复苏后4 h,仅HSH组能维持理想的MAP及较低的ICP,HSH组脑组织氧自由基含量较其他组明显减少(P<0.05).病理学检查显示复苏后4 h,HSH组的脑组织损伤较其他组轻.结论 高渗氯化钠羟乙基淀粉40注射液可有效地复苏失血性休克,降低ICP及氧自由基的生成,减轻脑组织缺血/再灌注的损伤.     

高渗氯化钠羟乙基淀粉40成人腰-硬联合麻醉的应用

目的观察高渗氯化钠羟乙基淀粉40(HSH)预防妇科下腹部手术腰-硬联合麻醉(CSEA)低血压的效果及其对生理功能的影响。方法选择10个研究中心行妇科下腹部手术CSEA麻醉患者480例,随机分为四组:Ⅰ组HSH4ml/kg,Ⅱ组HSH6ml/kg,Ⅲ组6%羟乙基淀粉130/0.4(HES130/0.4)7ml/kg,Ⅳ组复方氯化钠10ml/kg,均于麻醉前输注上述液体。记录液体输注前及麻醉后BP、HR变化。同时抽取对侧肢体静脉血检测电解质、Hb、Hct及凝血功能。结果Ⅳ组麻醉后BP显著低于麻醉前及其他三组(P0.05)。与麻醉前比较,Ⅰ、Ⅱ组电解质变化显著(P0.05),Ⅰ、Ⅱ、Ⅲ组Hb及Hct均显著下降(P0.05),Ⅱ、Ⅲ组凝血时间延长(P0.05)。结论预注HSH可有效预防CSEA引起的低血压,但对电解质、凝血功能、Hb及Hct产生一定影响。     

6%羟乙基淀粉130/0.4用于急性重型颅脑损伤手术的临床观察

目的 本文旨在规察6%羟乙基淀粉130/0.4(简称HES,下同)和高渗氯化钠羟乙基淀粉40注射液用于急性重型颅脑损伤手术的临床价值.方法 我院2007年9月至2008年3月完成急性重型颅脑损伤手术40例,随机均分为两组:HES组(Ⅰ组)和高渗氯化钠羟乙基淀粉40注射液组(Ⅱ组).分别于术前输注HES 20 ml/kg和高渗氯化钠羟乙基淀粉40注射液5 ml/kg.于治疗前(T1)、容量负荷后(T2)、麻酐诱导后(T3)、硬脑膜切开时(T4)、手术结束时(T5)五个时点记录颅内压(ICP)、脑氧分压(PbrO2);测量术前及术后24 h血S100β蛋白含量,记录术中液体总出入量和不良反应,并于术后3个月时根据格拉斯哥预后评分法(Glasgow outcome score,GOS)判定疗效.结果 ICP除T5时Ⅰ组低于Ⅱ组,而同时PbrO2Ⅰ组则高于Ⅱ组(P<0.01)外,其他各时点差异无统计学意义.凝血参数由术前正常转为异常者Ⅰ组有2例,Ⅱ组有4例;术中皮肤红斑Ⅱ组有3例.两组术后24 h血液S100β蛋白含量与术前比较均有显著升高(P<0.05);其中Ⅰ组血液S100β蛋白含量上升差值较Ⅱ组低,但差异无统计学意义.预后结果组间差异无统计学意义.结论 急性重型颅脑损伤术前应用6%羟乙基淀粉130/0.4较高渗氯化钠羟乙基淀粉40注射液能更好地降低颅内压,改善脑组织微循环及氧供,预后相似.     

不同液体复苏对失血性休克-内毒素二次打击大鼠急性肺损伤的影响

目的 比较不同液体复苏对失血性休克-内毒素二次打击大鼠急性肺损伤的影响.方法 60只雄性SD大鼠,体重250～280 g,随机分为5组(n=12):假手术组(S组)、失血性休克-内毒素组(SL组)、乳酸钠林格氏液组(LR组)、7.5%氯化钠组(HS组)和羟乙基淀粉(HES)130/0.4组(HES组).分为院前期(90 min)、院内复苏期(1 h)和复苏后观察期(3.5 h).院前期:SL组、LR组、HS组和HES组颈总动脉放血建立失血性休克模型(维持MAP 35～45 mm Hg 60 min)后,气管内注射内毒素2mg/kg,同时断尾,注射内毒素后即刻分别经30 min静脉输注3倍放血量的乳酸钠林格氏液、7.5%氯化钠4ml/kg和等放血量的6%HES 130/0.4;院内复苏期:结扎尾部断端止血,在1 h内回输全部放出的血液及等放血量的0.9%氯化钠;复苏后观察期3.5 h时采集动脉血样,进行血气分析,计算肺组织湿/干重量比(W/D)和肺通透指数(PPI),测定肺泡灌洗液(BALF)蛋白浓度和肺组织AQP-1 mRNA和AQP-5mRNA表达水平,光镜下观察肺组织病理学结果,记录大鼠存活情况.结果 与SL组和LR组比较,HS组和HES组MAP、pH值、PaO2和SaO2升高,血乳酸浓度、BE、W/D、PPI和BALF蛋白浓度降低,HS组肺组织AQP-1 mRNA表达上调,HES组肺组织AQP-1 mRNA和AQP-5 mRNA表达上调,大鼠存活率升高(P＜0.05或0.01);与HS组比较,HES组W/D降低,AQP-5 mRNA表达上调,大鼠存活率升高(P＜0.05),肺组织损伤程度减轻.结论 6%HES 130/0.4和7.5%氯化钠可减轻失血性休克-内毒素二次打击大鼠急性肺损伤,6%HES 130/0.4的效果更好,其机制与抑制AQP-1和(或)AQP-5表达下调有关;而乳酸钠林格氏液对其无效.     

托烷司琼与利多卡因预防高渗晶胶溶液静脉滴注痛效果的比较

<正>高渗氯化钠羟乙基淀粉40(HSH40)注射液为高渗晶胶混合液,含4.2%的氯化钠和7.6%的羟乙基淀粉,渗透浓度为1 440mOsm/L,其作用机理是高渗氯化钠通过渗透浓度梯度将细胞内液和组织间液转移至血管内,以自体输液的方式扩充血容量。由于HSH40高渗离子的刺激作用,在静脉滴注过程中可出现疼痛。产科麻醉中常用HSH40来防治低血压,本研究比较托烷司琼和利多卡因预防HSH40静脉     

羟乙基淀粉对内毒素血症大鼠肠系膜细静脉白细胞活化和血管通透性的影响

目的 探讨羟乙基淀粉(HES 130/0.4)对内毒素血症早期大鼠肠系膜细静脉白细胞活化及血管通透性的影响.方法 雄性Wistar大鼠36只,体重200～250 g,随机分为3组(n=12):对照组(C组)静脉注射生理盐水0.5 ml后,静脉输注生理盐水16 ml·kg-1·h-1;内毒素组(LPS组)静脉注射LPS 2 mg/ks(溶于生理盐水0.5 ml)后,静脉输注生理盐水16 ml·kg-1·h-1;HES组静脉注射LPS 2ms/kg(溶于生理盐水0.5 ml)后,静脉输注HES 16 ml·kg-1·h-1.各组补液时间60 min.观察给药前及补液期间和补液后30 min内肠系膜细静脉白细胞滚动数、粘附数、游出数、肥大细胞脱颗粒情况及细静脉血管通透性情况,检测外周血白细胞粘附分子CD11b和CD18的表达.结果 与C组比较,LPS组沿肠系膜细静脉内滚动、粘附和游出的白细胞增加,肥大细胞脱颗粒率增加,LPS组和HES组CD11b、CD18表达上调,细静脉血管通透性增加(P＜0.05).与LPS组比较,HES组上述指标均降低(P＜0.05).结论 HES 130/0.4可抑制内毒素血症早期大鼠肠系膜细静脉白细胞沿血管壁滚动、粘附和游出,抑制肥大细胞脱颗粒及血管通透性的增加,从而改善微循环障碍.     

小容量高渗氯化钠羟乙基淀粉40注射液对小鼠局灶性脑缺血/再灌注损伤的影响

目的研究高渗氯化钠羟乙基淀粉40注射液(hypertomic sodiam chloride hydroxyethyl starch 40 injection,HSH)对小鼠局灶性脑缺血/再灌注损伤（ischemia/reperfusion injury,I/RI）的影响。方法30只昆明种小鼠,应用随机排列表进行随机分...     

不同液体容量复苏对失血性休克犬血管外肺水的影响

目的 评价不同液体容量复苏对失血性休克犬血管外肺水的影响。方法 杂种犬32只,雌雄不拘,随机分为4组：NS组、HES组、HS组和HHS组,每组8只,股动脉放血建立失血性休克模型后,各组分别静脉输注容积相当于3倍失血量的生理盐水、失血量等容积的6%羟乙基淀粉130/0．4溶液、7．5%氯化钠溶液6 ml/kg及7．5%氯化钠-6%羟乙基淀粉130/0．4溶液6 ml/kg行容量复苏。经右颈内静脉持续监测中心静脉压、右股动脉置入PiCCO导管监测平均动脉压、心脏指数、每搏输出量、体循环阻力指数、血管外肺水指数及全心舒张末期容量指数,记录放血之前（基础值）、失血性休克模型成功即刻、容量复苏开始后5、30、60、120及180min的上述指标。结果 （1）各组在失血性休克的早期复苏中均可改善血液动力学,HES组、HHS组、HS组和NS组血液动力学改善持续时间依次缩短;（2）复苏早期HS组与HHS组血管外肺水无增加,NS组明显增加,而HES组下降。结论 （1） 7．5%氯化钠溶液与7．5%氯化钠-6%羟乙基淀粉130/0．4溶液小容量液体复苏可有效恢复犬失血性休克早期血液动力学的稳定,且不增加休克后血管外肺水,7．5%氯化钠-6%羟乙基淀粉130/0．4溶液效果较好;（2）6%羟乙基淀粉130/0．4溶液用于犬失血性休克早期复苏不仅可以改善血液动力学,而且能防止复苏后肺水肿。     

高渗氯化钠羟乙基淀粉40注射液急性高容量血液稀释对全麻患者液体平衡的影响

目的 观察高渗氯化钠羟乙基淀粉40注射液(HSH 40)急性高容量血液稀释(AHH)对胃癌根治术患者血流动力学和液体平衡的影响.方法 胃癌根治术患者50例.随机均分为HSH40组(A组)和羟乙基淀粉组(B组),全麻诱导5 min后分别予HSH 40和羟乙基淀粉6 ml/kg行AHH,30min内输完,记录输液开始时(T_0)、输液30 min时(T_1)、输液60 min时(T_2)和手术结束时(T_3)的HR、MAP、CVP,统计术中输液量、出血量、尿量.结果 组间组内各时点HR、MAP差异无统计学意义.两组T_1～T_3时CVP较T_0时明显升高(P<0.05);A组尿量较B组增多(P<0.05).结论 HSH 40进行AHH时,术中正平衡量减小,液体负平衡提早出现,患者水肿轻,利于康复.     

高渗氯化钠-羟乙基淀粉用于前列腺电切术的可行性

目的:研究前列腺肥大的患者在腰硬联合麻醉下行前列腺电切术时输注高渗氯化钠-羟乙基淀粉(hypertonic sodium chloride hetastarch,HSH)预防经尿道电切综合征的作用.方法:随机将60例前列腺肥大患者分为A组(观察组)和B组(对照组)各30例.观察组术前先输注复方氯化钠,手术开始后输注HS...     

6%羟乙基淀粉130/0.4液体复苏对创伤性脑损伤合并失血性休克大鼠的脑保护作用

目的 探讨6%羟乙基淀粉130/0.4(6%HES 130/0.4)液体复苏对创伤性脑损伤合并失血性休克大鼠的脑保护作用.方法 健康成年雄性SD大鼠60只,体重300～350 g,随机分为5组(n=12):假手术组(S组)、模型组(M组)、生理盐水组(NS组)、6%.HES 130/0.4组(HES组)和晶体.胶体高渗透压混合液组(HHS组).分别参照Feeney改良法和Wiggers改良法制备大鼠创伤性脑损伤模型和失血性休克模型.S组仅切开头皮,钻开骨窗,不制备创伤性脑损伤和失血性休克模型;M组制备创伤性脑损伤和失血性休克模型;其余3组均制备创伤性脑损伤和失血性休克模型,并于休克60 min时开始复苏.NS组经股静脉输注3倍于放血量的生理盐水;HES组经股静脉输注等于放血量的6%HES 130/0.4;HHS组经股静脉输注等于放血量的HHS(10%HES 130/0.4与7.5%NaCl按1:1混合),各复苏组均在30 min内将液体输注完毕.实验期间记录平均动脉压(MAP),采用ELISA法测定血清S-100β蛋白浓度;于复苏180 min时取脑组织,计算脑组织含水量,采用EUSA法测定脑组织TNF-α和IL-6的含量.结果 与M组比较,NS组、HES组和HHS组复苏后MAP和脑组织含水量升高,HES组脑组织TNF-α和IL-6的含量降低,HES组和HHS组复苏后血清S-100蛋白浓度降低(P<0.05),NS组血清S-100β蛋白浓度差异无统计学意义(P>0.05);与NS组比较,HES组和HHS组复苏后MAP升高,脑组织含水量和血清S-100β蛋白浓度均降低,HES组脑组织TNF-α和IL-6的含量降低(P<0.05);与HES组比较,HHS组脑组织TNF-α和IL-6的含量升高,血清S-100β蛋白浓度升高(P<0.05),MAP差异无统计学意义(P>0.05).结论 6%HES 130/0.4液体复苏可对创伤性脑损伤合并失血性休克大鼠产生脑保护作用,且该作用强于HHS,其脑保护作用的机制可能与降低脑组织炎性反应有关.     

羟乙基淀粉130/0.4对内毒素致大鼠急性肺损伤时TLR4表达的影响

目的 探讨羟乙基淀粉130/0.4对内毒素致大鼠急性肺损伤(ALI)时Toll样受体4(TLR4)表达的影响.方法 雄性SD大鼠30只,体重250～300 g,随机分为5组(n=6),生理盐水对照组(NS组)、ALI组和H_(1-3)组.ALI组、H_1组和H_2组经右颈内静脉注射内毒素10ms/kg制备大鼠ALI模型,H_1组和H_2组注射内毒素完毕1 min后,右颈内静脉分别输注6%羟乙基淀粉130/0.4 15和30ml/kg,H_3组仅右颈内静脉输注6%羟乙基淀粉130/0.4 30 ml/kg,速率均为0.2 ml/min.注射内毒素后6 h时处死大鼠取肺,光镜下观察肺组织病理学;采用RT-PCR检测TLR4 mRNA的表达水平,Western bloting法检测肺组织TLR4蛋白的表达水平.结果 与NS组相比,ALI组TLR4 mRNA和蛋白的表达上调(P＜0.05),H_3组差异无统计学意义(P＞0.05);与ALI组相比,H_1组和H_2组TLR4 mRNA和蛋白的表达下调(P＜0.05);H_1组和H_2组TLR4 mRNA和蛋白的表达比较差异无统计学意义(P＞0.05).病理结果显示:H_1组和H_2组肺损伤程度较ALI组明显减轻.结论 羟乙基淀粉130/0.4可能通过抑制TLR4表达上调,减轻炎性反应,从而减轻内毒素致大鼠ALI.     

Hyperosmolar volume replacement in heart surgery]

The ideal solution for use in volume therapy is still a matter of debate. Hypertonic sodium (HS) solutions have been advocated for resuscitation from hemorrhagic shock (small volume resuscitation). As hypertonic fluids may also be of interest in cardiac surgery, the effects of a new HS solution were studied. METHODS. In 90 patients undergoing aorto-coronary bypass grafting studies were performed at three different periods: I (n = 30) after induction of anesthesia (before onset of the operation); II (n = 30) during cardiopulmonary bypass (CPB); III (n = 30) after termination of bypass. During these periods the patients were randomly allocated to one of three groups with 10 patients in each group: group 1 received a new hypertonic solution prepared in hydroxyethyl starch (HES) solution (72 g/l NaCl, 60 g/l HES, 2400 mosmol/l; HS-HES patients), group 2 received a 6% HES solution (200/0.5; HES patients), and group 3 received no volume infusion and served as controls. RESULTS. After the induction of anesthesia, significantly less HS-HES solution (4.5 +/- 0.5 ml/kg) than 6% HES solution (10.1 +/- 1.4 ml/kg) was necessary to double the baseline PCWP. The fluid balance during CPB was negative in the patients who had received HS-HES preoperatively (-0.03 +/- 0.01 ml/kg.min CPB), whereas 6% HES (+0.06 +/- 0.02 ml/kg.min CPB) and control patients (+0.13 +/- 0.03 ml/kg.min CPB) had a positive fluid balance. Both after the induction of anesthesia and after termination of bypass, CI increased more in the HS-HES group than in the HES patients, and it even decreased in the control group. SVR decreased in the HS-HES patients, whereas it increased in the control group. Rapid infusion of HS-HES during CPB was followed by a significant, but short-lasting decrease in MAP (-40 mmHg) and an increase in the oxygenator volume. Pulmonary gas exchange (= paO2) was least compromised in the HS-HES patients; the sodium concentration increased only in the HS-HES patients, but never exceeded 150 mmol/l. DISCUSSION. Cardiac surgery procedures offer a special situation for volume therapy as there is a possibility of deterioration in the macro- and microcirculation before, after, and during the period of CPB. Hemodynamic effects of the new HS-HES solution included an increase in CI and a decrease in SVR, which were not merely transient as has been reported which hypertonic saline solution used alone. It was also observed that HS-HES patients required significantly smaller volumes of fluids, both during CPB and during the early postoperative period. This effect seems to be due to a redistribution of interstitial fluid to the intravascular space, possibly decreasing tissue edema. CONCLUSION. The hypertonic saline HES solution adds a new dimension to volume therapy for cardiac surgery patients. The improvement in hemodynamics was effective and not only transient. Fluid requirements were significantly reduced during as well as after CPB, and pulmonary gas exchange was least compromised in these patients.     

Acute preoperative hemodilution in cardiac surgery: volume replacement with a hypertonic saline-hydroxyethyl starch solution.

Preoperative hemodilution (HD) is a recommended practice in cardiac surgery that conserves blood and reduces the complications of homologous blood transfusion. In 45 patients undergoing myocardial revascularization, HD was performed preoperatively. Withdrawn volume (10 mL/kg) was replaced either by a new hypertonic saline (HS) solution prepared in hydroxyethyl starch (HES) (2,400 mOsm/L, HS-HES group, n = 15) or by a standard low molecular weight hydroxyethyl starch solution (6% HES 200/0.5, HES group, n = 15) to maintain baseline PCWP (acute normovolemic hemodilution [ANH]). Fifteen comparable patients without HD served as controls. Significantly less HS-HES (210 +/- 20 mL) than HES 6% (890 +/- 90 mL) was necessary to sustain hemodynamics during HD. Stable cardiocirculatory conditions were obtained even after termination of bypass. Fluid balance during cardiopulmonary bypass as well as in the postoperative period was significantly lower in HS-HES-treated patients. With regard to hemodynamics, CI increased most in the HS-HES group (+36%), whereas systemic vascular resistance was lower in these patients. Right ventricular ejection fraction increased only in HS-HES patients (+15%). However, sodium concentration as well as osmolarity increased after volume replacement with HS-HES, without exceeding normal values. None of the patients suffered from organ failure. Pulmonary gas exchange (PaO2) was less compromised in the HS-HES patients. There were no renal function differences between the groups. In conclusion, HS solution prepared in HES is an attractive alternative for blood substitution in cardiac patients undergoing acute hemodilution for blood conservation.     

Cardiorespiratory responses to hypertonic saline solution in cardiac operations

Infusion of small volumes of hypertonic saline solution (HS) seems to be of benefit in patients with impaired perfusion. The cardiorespiratory response to a 7.2% NaCl solution prepared in hydroxyethylstarch (HES) solution was investigated prospectively in patients undergoing prolonged cardiopulmonary bypass (CPB) (HS-HES group; n = 15); 6% HES 200/0.5 solution was infused in a control group (HES group; n = 15). Volume was given preoperatively to double low pulmonary artery occlusion pressure (less than 4 mm Hg) within 20 minutes. Hemodynamics, oxygen transport variables, and pulmonary gas exchange were studied before and after infusion as well as before and after CPB. Significantly less HS-HES solution (3.06 +/- 0.2 mL/kg) than 6% HES 200/0.5 solution (10.3 +/- 0.9 mL/kg) was necessary to double baseline pulmonary artery occlusion pressure. Fluid balance during CPB was negative in the HS-HES patients (-0.05 mL/kg.min CPB) and was lowest in this group even 5 hours after CPB. Mean arterial pressure, pulmonary arterial pressure, and heart rate were without differences between the groups. Changes in cardiac index (+40%) and total systemic resistance (-25%) were significantly most pronounced in the HS-HES patients, continuing even until the end of operation. Pulmonary gas exchange (arterial oxygen tension, intrapulmonary right-to-left shunting) was least compromised in these patients, particularly after bypass. Oxygen consumption was without difference between the groups; oxygen delivery increased significantly more in the HS-HES patients due to the larger increase in cardiac output.(ABSTRACT TRUNCATED AT 250 WORDS)     

Early hemodynamic and renal effects of hemorrhagic shock resuscitation with lactated Ringer's solution, hydroxyethyl starch, and hypertonic saline with or without 6% dextran-70

BACKGROUND: Considering the renal effects of fluid resuscitation in hemorrhaged patients, the choice of fluid has been a source of controversy. In a model of hemorrhagic shock, we studied the early hemodynamic and renal effects of fluid resuscitation with lactated Ringer's (LR), 6% hydroxyethyl starch (HES), and 7.5% hypertonic saline (HS) with or without 6% dextran-70 (HSD). MATERIALS AND METHODS: Forty-eight dogs were anesthetized and submitted to splenectomy. An estimated 40% blood volume was removed to maintain mean arterial pressure (MAP) at 40 mm Hg for 30 min. The dogs were divided into four groups: LR, in a 3:1 ratio to removed blood volume; HS, 6 mL kg(-1); HSD, 6 mL kg(-1); and HES in a 1:1 ratio to removed blood volume. Hemodynamics and renal function were studied during shock and 5, 60, and 120 min after fluid replacement. RESULTS: Shock treatment increased MAP similarly in all groups. At 5 min, cardiac filling pressures and cardiac performance indexes were higher for LR and HES but, after 120 min, there were no differences among groups. Renal blood flow and glomerular filtration rate (GFR) were higher in LR at 60 min but GFR returned to baseline values in all groups at 120 min. Diuresis was higher for LR at 5 min and for LR and HES at 60 min. There were no differences among groups in renal variables 120 min after treatment. CONCLUSIONS: Despite the immediate differences in hemodynamic responses, the low-volume resuscitation fluids, HS and HSD, are equally effective to LR and HES in restoring renal performance 120 min after hemorrhagic shock treatment.     

Cerebrovascular effects of small volume resuscitation from hemorrhagic shock: comparison of hypertonic saline and concentrated hydroxyethyl starch in dogs

To determine if hypertonic and hyperoncotic resuscitation solutions exerted comparable effects on cerebral hemodynamics following hemorrhagic shock, we compared randomly assigned, equal volumes (6.0 ml/kg) of hypertonic (7.2%) saline (HS) and hyperoncotic (20%) hydroxyethyl starch (HES) for resuscitation from acute experimental hemorrhage in 12 anesthetized dogs. Regional cerebral blood flow (radiolabeled microspheres), intracranial pressure (cisternal catheter), and systemic hemodynamics were recorded. Rapid hemorrhage reduced the mean arterial pressure to 45 mm Hg for 30 min. Resuscitation fluids were infused over 5 min. Both fluids restored mean arterial pressure and cardiac output equally. However, at 60 min following resuscitation, cardiac output decreased in the HS group in comparison to the HES group (1.7 +/- 0.1 vs. 3.1 +/- 0.2 L/min, p <0.05). Cardiac output rapidly declined, however, in the HS group in comparison to the HES group (p <0.05 60 min following resuscitation). Intracranial pressure and cerebral perfusion pressure were similar at all intervals. Regional cerebral blood flow was similar following both fluids. Neither fluid restored cerebral oxygen transport to baseline values. Based on these data, the authors conclude that, following severe hemorrhagic shock of brief duration, systemic and cerebral hemodynamic values are restored equally well by highly concentrated colloid or by hypertonic saline, although hypertonic saline only transiently improves cardiac output.     

p38MAPK/iNOS/HO-1信号通路在赤芍减轻大鼠内毒素性急性肺损伤中的作用

目的 评价p38MAPK/iNOS/HO-1信号通路在赤芍减轻大鼠内毒素性急性肺损伤(AL1)中的作用.方法 健康清洁级雄性Wistar大鼠40只,随机分为5组(n=8):生理盐水对照组(C组)、内毒素组(L组)、赤芍组(R组)、赤芍预处理组(PR组)和SB203580组(S组).气管内滴注脂多糖(LPS)制备大鼠ALI模型.L组气管内滴注1 ml LPS溶液(2.5 mg/kg);C组滴注等容量生理盐水;R组、PR组分别于气管内滴注LPS后、滴注前2 h,经股静脉输注赤芍注射液15 mg·kg-1·h-1 2 h;S组于气管内滴注LPS前3 h,经股静脉输注SB203580溶液2.5 μmol·kg-1·h-1 3 h.于气管内滴注LPS后6 h时,经颈动脉采血样2 ml,行血气分析及测定血清NO浓度;颈动脉放血处死大鼠,测定支气管肺泡灌洗液蛋白浓度,计数中性粒细胞及细胞总数,检测肺组织MDA含量,p38MAPK、HO-1及iNOS的表达.观察肺组织病理学结果 .结果 与C组比较,其余各组肺组织p38MAPK、iNOS及HO-1表达上调,支气管肺泡灌洗液中性粒细胞计数比、蛋白浓度、肺组织MDA含量及血清NO浓度升高.PaO2和HCO1浓度降低(P<0.01);与L组比较,R组、PR组和S组p38MAPK及iNOS表达下调,HO-1表达上调.支气管肺泡灌洗液中性粒细胞计数比、蛋白浓度、肺组织MDA含量及血清NO浓度降低,PaO2和HCO3-升高(P<0.05);R组、PR组和S组肺组织损伤程度较L组减轻.结论 赤芍可减轻大鼠内毒素性急性肺损伤,可能与抑制p38MAPK/iNOS/HO-1信号通路有关.     

瑞芬太尼预先给药对兔心肌缺血再灌注时脂质过氧化反应的影响

目的 评价瑞芬太尼预先给药对兔心肌缺血再灌注时脂质过氧化反应的影响.方法 家兔40只,雌雄不拘,体重1.5～2.5 kg,随机分为5组(n=8),Ⅱ组、Ⅲ组和V组采用静脉注射垂体后叶素2.5 U/kg的方法制备急性心肌缺血模型,Ⅰ组和Ⅳ组给予等容量生理盐水.Ⅲ组静脉注射吗啡3.3 mg/kg后30 min给予垂体后叶素前;Ⅳ组静脉输注瑞芬太尼3.3μg·kg-1·min-130 min时给予生理盐水;V组静脉输注瑞芬太尼3.3μg·kg-1·min-1 30 min时给予垂体后叶素.于给予垂体后叶素前即刻(T1)、给予垂体后叶素后24 h(T2)、48 h(T3)时采集颈内静脉血样,测定血清心肌肌钙蛋白I(cTnI)浓度.取心肌组织,测定超氧化物歧化酶(SOD)活性及丙二醛(MDA)含量.电镜下观察心肌组织超微结构.结果 与Ⅰ组比较,Ⅱ组血清cTnI浓度和心肌组织MDA含量升高,心肌组织SOD活性降低(P＜0.01);与Ⅱ组比较,Ⅲ组及V组血清cTnI浓度和MDA含量降低,心肌组织SOD活性升高(P＜0.05或0.01).电镜下Ⅴ组心肌损伤程度轻于Ⅱ组.结论瑞芬太尼预先给药可抑制脂质过氧化反应,从而减轻兔心肌缺血再灌注损伤.     

Rebound intracranial hypertension in dogs after resuscitation with hypertonic solutions from hemorrhagic shock accompanied by an intracranial mass lesion

We compared intracranial pressure (ICP) and cerebral blood flow (CBF) in dogs after inflating a subdural intracranial balloon to increase ICP to 20 mm Hg, inducing hemorrhagic shock (mean arterial pressure [MAP] of 55 mm Hg), and infusing a single bolus of fluid consisting of either 54 mL/kg of 0.8% saline (SAL), 6 mL/kg of 7.2% hypertonic saline (HS), 20% hydroxyethyl starch (HES) in 0.8% SAL, or a combination fluid (HS/HES) containing 20% HES in 7.2% saline. Twenty-six dogs were ventilated with 0.5% halothane in N2O and O2 (60:40 ratio). As ICP was maintained at 20 mm Hg, rapid hemorrhage reduced MAP to 55 mm Hg (time interval of zero [T0]) which was maintained at that level for 30 minutes (until T30). Subsequently, over a 5-minute interval (T30-T35), one of the four randomly assigned resuscitation fluids was infused. Data were collected at baseline; after subdural balloon inflation; at T0, T30, T35, and 30-minute intervals thereafter for 2 hours (T65, T95, T125, and T155). CBF and ICP were compared using repeat-measure ANOVA. Cerebral blood flow was greater at T35 in the HS and HS/HES groups than in the HES group (P = .025). In the SAL group, ICP increased significantly from T0 to T35, remaining unchanged thereafter. At T35, ICP in the HS group was significantly lower than in the SAL group (P < .05) but subsequently increased. ICP in the HS/HES group exceeded that in all other groups at T95 and T125 (P < .05). After a severe reduction in cerebral perfusion pressure (CPP), HS solutions (both HS and HS/HES) were associated with a delayed rise in ICP and did not improve global forebrain CBF in comparison with conventional saline solutions.